Evaluating the Epley maneuver.

Evidence Six systematic reviews of RCTs consistently supported Epley maneuvers (as classically described) despite considerable heterogeneity among trials.1-6 • Most recent review (11 RCTs, N = 745)1: -Results were statistically significant for the Epley maneuver versus control at 24 hours and 4 weeks. —Resolution of symptoms (5 RCTs, n = 273): 56% versus 21% with control (NNT = 3). —Positive to negative Dix-Hallpike test result (8 RCTs, n = 507): 80% versus 37% with control (NNT = 3). • A few small studies compare the Epley to other maneuvers and report equivalence (eg, Semont and Gans) or inferiority (eg, Brandt-Daroff) of these interventions. Two systematic reviews looked at movement restriction after the Epley maneuver, such as a neck brace or postural advice (avoid lying on affected side for 1 to 5 days and sleep upright for 24 to 48 hours).7,8 They had slightly different inclusion criteria leading to different conclusions.7,8 • Larger review (9 RCTs, N = 1078)7: -Resolution of symptoms and negative Dix-Hallpike test result: 86% versus 85% without restriction. • Smaller review8: -Resolution of symptoms (2 RCTs, n = 119): 52% versus 41% without restrictions (not statistically different). -Negative Dix-Hallpike test result (9 RCTs, n = 528): 89% versus 78% without restrictions (statistically different).